Summary: Each year in the US, over 195,000 active dental practitioners provide care to more than 127 million patients, expending more than $117 billion annually. In so doing, they routinely perform highly technical and risky procedures in complex environments, work in teams and use a multitude of devices and tools. Each dental clinic represents a system that aspires to provide high quality, safe care to its patients. These systems fall short of that goal ? even to the point of patient death. We have been motivated to focus on dental patient safety because little had been done in this arena. Our investigative patient safety work has shown that harms to patients are commonplace in dentistry. Through the support of the NIH (R01DE022628), we have developed and tested a Patient Safety Toolkit (PST) for documenting adverse events (AEs) in the dental setting. Using this PST, we have developed a data repository to systematically organize dental AEs into a searchable database and dental AE type and severity classification systems. Further, we have estimated the incidence of dental AEs and impact on disparity populations through large scale chart reviews in AHRQ (R01HS024406). Our long-term goal is to build a sustainable dental learning health system focused on continuous quality improvement and providing patients with safe and effective oral healthcare. The objective of this application is to advance the dental Patient Safety Initiative (PSI) by translating our findings from identification of dental AEs to implementing a learning laboratory at two large academic dental institutions. Using a systems engineering approach, the Open Wide Learning Lab (OWLL) will systematically identify threats to dental patient safety and iteratively test improvement strategies to prevent them. Applying the lessons learned from our prior work, our group is uniquely positioned to advance the PSI by developing a scalable, systems-based and multi-institutional dental patient safety learning lab. This program will arm sites with the capacity and tools to identify, investigate, and address patient safety incidents. We will develop and test this initiative at two large dental academic centers in Texas and California. In Aim 1 we identify and understand the contributing factors (conduct problem analysis) for commonly occurring dental adverse events. In Aim 2 we design and develop improvement strategies to prevent adverse events using a systems-based human- centered design processes. In aim 3 we implement and evaluate improvement strategies at 2 institutions and evaluate their impact on proximal and distal outcomes using a stepped-wedge, clustered randomized control trial. We expect that the development of the Dental Patient Safety Learning Lab will arm institutions with both the knowledge and know-how to reduce the occurrence of AEs in dental clinics.